Antibiotic prescribing on two medical wards at St Luke’s Hospital : what scope for improvement?

Antibiotics are frequently prescribed drugs and form a significant part of the hospital budget. The literature suggests that prescribing is not without problems and may need constant review. We have no data relating to our hospital. This study aims to explore some aspects of antibiotic use in our setting. Records of all patients prescribed antibiotics on two medical wards over a 4 month period were analysed for indication, choice of antibiotic, outcome and cost. There were 126 patients: 54% males; 75.4%, >60 years old; 62% were admitted because of infection. Of the whole group, 8.7% received antibiotics with no evidence of infection and no indication for prophylaxis. There were 118 infections, 64% respiratory, 13.5% urinary and the rest of miscellaneous sites; 14% of infections were nosocomial. Microbiological studies were available in only 29% of infections. For 6 patients, the antibiotics prescribed were relatively contraindicated because of impaired hepatic and renal function. There was one adverse drug reaction. The total drug cost was Lm2181.79; i.v. treatment accounted for 93% of this cost and ceftazidime for 60%. There is room for improvement in the selection of antibiotics and their route of administration. The hospital microbiologists and the Antibiotic Policy should be consulted more often. Laboratory diagnosis of infection and biochemical patient monitoring are inadequate. Restricting i.v. treatment could reduce cost very substantially.peer-reviewe

Asymmetric Ejecta of Cool Supergiants and Hypergiants in the Massive Cluster Westerlund 1

We report new 5.5 GHz radio observations of the massive star cluster Westerlund 1, taken by the Australia Telescope Compact Array, detecting nine of the ten yellow hypergiants (YHGs) and red supergiants (RSGs) within the cluster. Eight of nine sources are spatially resolved. The nebulae associated with the YHGs Wd1-4a, -12a and -265 demonstrate a cometary morphology - the first time this phenomenon has been observed for such stars. This structure is also echoed in the ejecta of the RSGs Wd1-20 and -26; in each case the cometary tails are directed away from the cluster core. The nebular emission around the RSG Wd1-237 is less collimated than these systems but once again appears more prominent in the hemisphere facing the cluster. Considered as a whole, the nebular morphologies provide compelling evidence for sculpting via a physical agent associated with Westerlund 1, such as a cluster wind

Clinical and financial consequences of setting up an asthma clinic at St. Luke’s Hospital

The effects of setting up an asthma clinic were assessed in an audit study. A comparison was made between the quality and quantity of medication used by patients before and after attending the asthma clinic. The number and severity of exacerbations during a six month period before and a six month period after attending were also assessed. The cost of treatment before and after was also calculated. In 14% of patients, occupational factors, drugs or underlying lung disease were significant contributors to asthma. The number of acute episodes of severe asthma were reduced from 98 to 47, with hospital admissions falling from 26 to 1. Pulmonary function (%FEV1) improved in the group as a whole with the number of patients having their best FEV above 80% improving from 44 to 71. In spite of the expense of high cost drugs and the running costs of the clinic there were substantial savings largely from the reduced number of hospital admissions. The calculated annual cost fell from Lm 22,769 to Lm 10,654.peer-reviewe

A quantitative PCR method for measuring absolute telomere length

We describe a simple and reproducible method to measure absolute telomere length (aTL) using quantitative real-time polymerase chain reaction (qPCR). This method is based on the Cawthon method for relative measurement of telomere length (TL) but modified by introducing an oligomer standard to measure aTL. The method describes the oligomer standards, the generation of the standard curve and the calculations required to calculate aTL from the qPCR data. The necessary controls and performance characteristics of the assay are described in detail and compared relative to other methods for measuring TL. Typical results for this assay for a variety of human tissue samples are provided as well as a troubleshooting schedule. This method allows high throughput measurement of aTL using small amounts of DNA making it amenable for molecular epidemiological studies. Compared to the traditional relative TL qPCR assays, the aTL method described in this protocol enables a more direct comparison of results between experiments within and between laboratories

Excavations at Tas-Silg, Malta : a preliminary report on the 1996-1998 campaigns conducted by the Department of Classics and Archaeology of the University of Malta

The area known as Tas-Silg is situated in the south-eastern part of the island of Malta, close to Marsaxlokk harbour. In reality the place name refers to the small church dedicated to Our Lady of the Snows (hence Tas-Silg) situated at the point where the narrow · road from Zejtun forks out in two directions: to Delimara and Xrobb il-Ghagin due south-east and to Marsaxlokk village due south-west. A British-period fort occupying the highest point of the elongated hill further south along· the first road also carries the same place name. The lower and more compact hill on which the excavations have been conducted is called 'Ta' Berikka' , but since it is so close to the above-mentioned church (only 50 m to the north) the tradition of calling it Tas-Silg is now well established and there is no sense in changing it. The site has a commanding view of the Marsaxlokk harbour to the south and overlooks two other bays, Marsascala and St Thomas's bay, to the north-east. On all sides the slope is broken up by man-made terraced fields There is no doubt that the topography of the site must have been a determining factor in its choice for the establishment of a religious centre in the Temple period of Maltese pehistory (3000--2500 BC), though one must keep in mind that close to Tas-Silg there are three other prehistoric temple sites. each one with a completely different topography. The Temple people were quite introverted in their cultural isolation and do not seem to have been much interested in seafaring and in the outside world. The situation changed radically in the following age, the Bronze Age. when the island was occupied by people who set up villages on naturally defensible hilltops, occasionally fortifying them with artificial ramparts. The Tas-Silg hill with its temple ruins was occupied by these people, but it is not as yet clear for what purpose. The scenario changed again in historical times when the central and western Mediterranean started to be parcelled out among the commercial powers originating in the eastern Mediterranean. The Greeks do not seem to have even tried 10 colonize Malta as they did in neighbouring Sicily. The Phoenicians, however, did occupy the island, apparently through a slow process of peaceful penetration and eventual political and cultural assimi lation. It was in this period that the ruins of the megalithic temple were transformed into a Phoenician extraurban shrine dedicated to Astarte, which in time expanded into a full y-fledged sanctuary with an international reputation. The last chapter in the millennia- long history of the site was written when the colonnaded courtyard in front of the old temple was transformed into an early Christian church. Any use made of the site in the following Arab period is, once again, poorly understood.peer-reviewe

ALMA observations of the supergiant B[e] star Wd1-9

Mass-loss in massive stars plays a critical role in their evolution, although the precise mechanism(s) responsible – radiatively driven winds, impulsive ejection and/or binary interaction – remain uncertain. In this Letter, we present Atacama Large Millimetre/Submillimeter Array line and continuum observations of the supergiant B[e] star Wd1-9, a massive post-main-sequence object located within the starburst cluster Westerlund 1 (Wd1). We find it to be one of the brightest stellar point sources in the sky at millimetre wavelengths, with (serendipitously identified) emission in the H41α radio recombination line. We attribute these properties to a low velocity (∼100 km s-1 ) ionized wind, with an extreme mass-loss rate ≳6.4 × 105(d/5 kpc)1.5 Mȯyr-1. External to this is an extended aspherical ejection nebula indicative of a prior phase of significant mass-loss. Taken together, the millimetre properties of Wd1-9 show a remarkable similarity to those of the highly luminous stellar source MWC349A. We conclude that these objects are interacting binaries evolving away from the main sequence and undergoing rapid case-A mass transfer. As such they – and by extension the wider class of supergiant B[e] stars – may provide a unique window into the physics of a process that shapes the life-cycle of ∼70 per cent of massive stars found in binary systems

Conference scene : Golden Helix Pharmacogenomics Days : educational activities on pharmacogenomics and personalized medicine

The Golden Helix Pharmacogenomics Days are high-profile international educational scientific meetings discussing pharmacogenomics and personalized medicine. Here, we provide an overview of the scientific lectures and the topics discussed during the 4th Golden Helix Pharmacogenomics Day, held in Cagliari, Italy, on 7 October 2011, and the 5th Golden Helix Pharmacogenomics Day, that was held in Msida, Malta, on 3 December 2011. The scientific programs of both events included scientific and company lectures on pharmacogenomics, bioinformatics and personalized medicine by local and international speakers from Europe and the USA.peer-reviewe

Deep MERLIN 5GHz Radio Imaging of Supernova Remnants in the M82 Starburst

The results of an extremely deep, 8-day long observation of the central kpc of the nearby starburst galaxy M82 using MERLIN (Multi-Element Radio Linked Interferometer Network) at 5 GHz are presented. The 17E-06 Jy/beam, rms noise level in the naturally weighted image make it the most sensitive high resolution radio image of M82 made to date. Over 50 discrete sources are detected, the majority of which are supernova remnants, but with 13 identified as HII regions. Sizes, flux densities and radio brightnesses are given for all of the detected sources, which are all well resolved with a majority showing shell or partial shell structures. Those sources within the sample which are supernova remnants have diameters ranging from 0.3 to 6.7 pc, with a mean size of 2.9 pc. From a comparison with previous MERLIN 5 GHz observations made in July 1992, which gives a 9.75 year timeline, it has been possible to measure the expansion velocities of ten of the more compact sources, eight of which have not been measured before. These derived expansion velocities range between 2200 and 10500 km/s.Comment: 34 pages, 10 figures. Accepted by MNRA

Precise determination of the structure factor and contact in a unitary Fermi gas

We present a high-precision determination of the universal contact parameter in a strongly interacting Fermi gas. In a trapped gas at unitarity we find the contact to be $3.06 \pm 0.08$ at a temperature of 0.08 of the Fermi temperature in a harmonic trap. The contact governs the high-momentum (short-range) properties of these systems and this low temperature measurement provides a new benchmark for the zero temperature homogeneous contact. The experimental measurement utilises Bragg spectroscopy to obtain the dynamic and static structure factors of ultracold Fermi gases at high momentum in the unitarity and molecular Bose-Einstein condensate (BEC) regimes. We have also performed quantum Monte Carlo calculations of the static properties, extending from the weakly coupled Bardeen-Cooper-Schrieffer (BCS) regime to the strongly coupled BEC case, which show agreement with experiment at the level of a few percent.Comment: Replaced with accepted versio